Provider Demographics
NPI:1124011101
Name:ABRAHAM, VANITHA EVANGELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANITHA
Middle Name:EVANGELINE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758952
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8952
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:107 S SPORTING HILL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3058
Practice Address - Country:US
Practice Address - Phone:717-943-1781
Practice Address - Fax:717-943-1782
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038840L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD71653Medicare UPIN
PA213827Medicare PIN
PA468296YEBKMedicare PIN